Ross T Tsuyuki

University of Alberta, Edmonton, Alberta, Canada

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Publications (288)974.19 Total impact

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    ABSTRACT: -Hypertension control rates remain suboptimal. Pharmacists' scope of practice is evolving and their position in the community may be ideal for improving hypertension care. We aimed to study the impact of pharmacist prescribing on blood pressure (BP) control in community-dwelling patients. -We designed a patient-level randomized controlled trial, enrolling adults with above-target BP (as defined by Canadian guidelines), through community pharmacies, hospitals, or primary care teams in 23 communities in Alberta. Intervention group patients received an assessment of BP and cardiovascular risk, education on hypertension, prescribing of antihypertensive medications, laboratory monitoring, and monthly follow-up visits for 6 months (all by their pharmacist). Control group patients received a wallet card for BP recording, written hypertension information, and usual care from their pharmacist and physician. Primary outcome was the change in systolic BP at 6 months. A total of 248 patients (mean age 64 years, 49% male) were enrolled. Baseline mean (SD) systolic/diastolic BP was 150(14)/84(11) mm Hg. The intervention group had a mean (SE) reduction in systolic BP at 6 months of 18.3 (1.2) compared with 11.8 (1.9) in the control group, an adjusted difference of 6.6 (1.9) mmHg (p=0.0006). The adjusted odds of patients achieving BP targets was 2.32 (95% CI 1.17, 4.15 in favor of the intervention). -Pharmacist prescribing for patients with hypertension resulted in a clinically important and statistically significant reduction in BP. Policymakers should consider an expanded role for pharmacists, including prescribing, to address the burden of hypertension. Clinical Trial Registration Information-clinicaltrials.gov; Identifier: NCT00878566.
    Circulation 06/2015; DOI:10.1161/CIRCULATIONAHA.115.015464 · 14.95 Impact Factor
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    ABSTRACT: Legislative changes are affording pharmacists the opportunity to provide more advanced pharmacy services. However, many pharmacists have not yet been able to provide these services sustainably. Research from implementation science suggests that before sustained change in pharmacy can be achieved an improved understanding of pharmacy context, through the professional culture of pharmacy and pharmacists' personality traits, is required. The primary objective of this study was to investigate possible relationships between cultural factors, and personality traits, and the uptake of advanced practice opportunities by pharmacists in British Columbia, Canada. The study design was a cross-sectional survey of registered, and practicing, pharmacists from one Canadian province. The survey gauged respondents' characteristics, practice setting, and the provision of advanced pharmacy services, and contained the Organizational Culture Profile (OCP), a measure of professional culture, as well as the Big Five Inventory (BFI), a measure of personality traits. A total of 945 completed survey instruments were returned. The majority of respondents were female (61%), the average age of respondents was 42 years (SD: 12), and the average number of years in practice was 19 (SD: 12). A significant positive relationship was identified for respondents perceiving greater value in the OCP factors competitiveness and innovation and providing a higher number of all advanced services. A positive relationship was observed for respondents scoring higher on the BFI traits extraversion and the immunizations provided, and agreeableness and openness and medication reviews completed. This is the first work to identify statistically significant relationships between the OCP and BFI, and the provision of advanced pharmacy services. As such, this work serves as a starting place from which to develop more detailed insight into how the professional culture of pharmacy and pharmacists personality traits may influence the adoption of advanced pharmacy services. Copyright © 2015 Elsevier Inc. All rights reserved.
    Research in Social and Administrative Pharmacy 05/2015; DOI:10.1016/j.sapharm.2015.05.003 · 2.35 Impact Factor
  • 04/2015; 68(2). DOI:10.4212/cjhp.v68i2.1438
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    ABSTRACT: To identify which activities produced a significant improvement in blood pressure control in patients with type 2 diabetes when pharmacists were added to primary care teams. This prespecified, secondary analysis evaluated medication management data from a randomized controlled trial. The primary outcome was a change in treatment, defined as addition, dosage increase, or switching of an antihypertensive medication during the 1-year study period. The secondary outcome was a change in antihypertensive medication adherence using the medication possession ratio (MPR). The 200 evaluable trial patients had a mean age of 59 (SD, 11) years, 44% were men, and mean blood pressure was 130 (SD, 16)/74 (SD, 10) mm Hg at baseline. Treatment changes occurred in 45 (42%) of 107 patients in the intervention group and 24 (26%) of 93 patients in the control group (RR, 1.63; 95% CI, 1.08-2.46). Addition of a new medication was the most common type of change, occurring in 34 (32%) patients in the intervention group and 17 (18%) patients in the control group (P = 0.029). Adherence to antihypertensive medication was high at baseline (MPR, 93%). Although medication adherence improved in the intervention group (MPR, 97%) and declined in the control group (MPR, 91%), the difference between groups was not significant (P = 0.21). The observed improvement in blood pressure control when pharmacists were added to primary care teams was likely achieved through antihypertensive treatment changes and not through improvements in antihypertensive medication adherence.
    Journal of the American Pharmacists Association 04/2015; 55(3):e301-e304. DOI:10.1331/JAPhA.2015.14225
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    ABSTRACT: Evidence for the value of pharmacists' interventions in the care of patients is strong and continues to grow, but the rate at which these new practice opportunities are being integrated into daily practice has not kept pace. The knowledge translation literature suggests that before effective change strategies can be implemented, a better understanding of the current environment must be obtained. Two important factors within the practice environment are the professional culture and personality traits of group members. To gain insight, at a national level, into the culture of hospital pharmacy, using the Organizational Culture Profile, and into hospital pharmacists' personality traits, using the Big Five Inventory. A cross-sectional survey of hospital pharmacists from across Canada was conducted intermittently over the period August 2012 to September 2013. The online survey contained questions about demographic characteristics and practice setting, as well as questions from the Organizational Culture Profile and Big Five Inventory. The survey link was distributed directly to hospital pharmacists or made available through provincial monthly newsletters. All data were analyzed descriptively and inferentially. In total, 401 surveys were returned. Descriptive analyses from the Organizational Culture Profile revealed that most respondents perceived value in the factors of supportiveness, competitiveness, and stability. Descriptive analyses from the Big Five Inventory revealed that respondents may have been more likely to exhibit behaviours in line with the trait of conscientiousness. Several significant subgroup differences were noted in relation to levels of education, regions of practice within Canada, years in practice, and proportion of time spent conducting clinical duties. The results from this survey provide preliminary insight into the professional culture and personality traits of Canadian hospital pharmacists. It will be important to explore these findings in more depth to maximize the success of any future practice change initiatives.
    The Canadian journal of hospital pharmacy 03/2015; 68(2):127-35.
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    ABSTRACT: Frailty is a multidimensional syndrome characterized by loss of physiologic reserve that gives rise to vulnerability to poor outcomes. We aimed to examine the association between frailty and long-term health-related quality-of-life among survivors of critical illness. Prospective multicenter observational cohort study. ICUs in six hospitals from across Alberta, Canada. Four hundred twenty-one critically ill patients who were 50 years or older. None. Frailty was operationalized by a score of more than 4 on the Clinical Frailty Scale. Health-related quality-of-life was measured by the EuroQol Health Questionnaire and Short-Form 12 Physical and Mental Component Scores at 6 and 12 months. Multiple logistic and linear regression with generalized estimating equations was used to explore the association between frailty and health-related quality-of-life. In total, frailty was diagnosed in 33% (95% CI, 28-38). Frail patients were older, had more comorbidities, and higher illness severity. EuroQol-visual analogue scale scores were lower for frail compared with not frail patients at 6 months (52.2 ± 22.5 vs 64.6 ± 19.4; p < 0.001) and 12 months (54.4 ± 23.1 vs 68.0 ± 17.8; p < 0.001). Frail patients reported greater problems with mobility (71% vs 45%; odds ratio, 3.1 [1.6-6.1]; p = 0.001), self-care (49% vs 15%; odds ratio, 5.8 [2.9-11.7]; p < 0.001), usual activities (80% vs 52%; odds ratio, 3.9 [1.8-8.2]; p < 0.001), pain/discomfort (68% vs 47%; odds ratio, 2.0 [1.1-3.8]; p = 0.03), and anxiety/depression (51% vs 27%; odds ratio, 2.8 [1.5-5.3]; p = 0.001) compared with not frail patients. Frail patients described lower health-related quality-of-life on both physical component score (34.7 ± 7.8 vs 37.8 ± 6.7; p = 0.012) and mental component score (33.8 ± 7.0 vs 38.6 ± 7.7; p < 0.001) at 12 months. Frail survivors of critical illness experienced greater impairment in health-related quality-of-life, functional dependence, and disability compared with those not frail. The systematic assessment of frailty may assist in better informing patients and families on the complexities of survivorship and recovery.
    Critical Care Medicine 01/2015; 43(5). DOI:10.1097/CCM.0000000000000860 · 6.15 Impact Factor
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    ABSTRACT: Background Adding pharmacists to primary care teams significantly improved blood pressure control and reduced predicted 10–year cardiovascular risk in patients with Type 2 diabetes. This pre-specified sub-study evaluated the economic implications of this cardiovascular risk reduction strategy.Methods One-year outcomes and healthcare utilization data from the trial were used to determine cost-effectiveness from the public payer perspective. Costs were expressed in 2014 Canadian dollars and effectiveness was based on annualized risk of cardiovascular events derived from the UKPDS Risk Engine.ResultsThe 123 evaluable trial patients included in this analysis had a mean age of 62 (± 11) years, 38% were men, and mean diabetes duration was 6 (± 7) years. Pharmacists provided 3.0 (± 1.9) hours of additional service to each intervention patient, which cost $226 (± $1143) per patient. The overall one-year per-patient costs for healthcare utilization were $190 lower in the intervention group compared with usual care [95% confidence interval (CI): $1040, $668). Intervention patients had a significant 0.3% greater reduction in the annualized risk of a cardiovascular event (95% CI: 0.08%, 0.6%) compared with usual care. In the cost-effectiveness analysis, the intervention dominated usual care in 66% of 10 000 bootstrap replications. At a societal willingness-to-pay of $4000 per 1% reduction in annual cardiovascular risk, the probability that the intervention was cost-effective compared with usual care reached 95%. A sensitivity analysis using multiple imputation to replace missing data produced similar results.Conclusions Within a randomized trial, adding pharmacists to primary care teams was a cost-effective strategy for reducing cardiovascular risk in patients with Type 2 diabetes. In most circumstances, this intervention may also be cost saving.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 01/2015; 32(7). DOI:10.1111/dme.12692 · 3.06 Impact Factor
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    ABSTRACT: Background: Despite evidence of benefit for pharmacist involvement in chronic disease management, the provision of these services in community pharmacy has been suboptimal. The Promoting Action on Research Implementation in Health Services (PARiHS) framework suggests that for knowledge translation to be effective, there must be evidence of benefit, a context conducive to implementation, and facilitation to support uptake. We hypothesize that while the evidence and context components of this framework are satisfied, that uptake into practice has been insufficient because of a lack of facilitation. This protocol describes the rationale and methods of a feasibility study to test a facilitated pharmacy practice intervention based on the PARiHS framework, to assist community pharmacists in increasing the number of formal and documented medication management services completed for patients with diabetes, dyslipidemia, and hypertension. Methods: A cluster-randomized before-after design will compare ten pharmacies from within a single organization, with the unit of randomization being the pharmacy. Pharmacies will be randomized to facilitated intervention based on the PARiHS framework or usual practice. The Alberta Context Tool will be used to establish the context of practice in each pharmacy. Pharmacies randomized to the intervention will receive task-focused facilitation from an external facilitator, with the goal of developing alternative team processes to allow the greater provision of medication management services for patients with diabetes, hypertension, and dyslipidemia. The primary outcome will be a process evaluation of the needs of community pharmacies to provide more clinical services, the acceptability and uptake of modifications made, and the willingness of pharmacies to participate. Secondary outcomes will include the change in the number of formal and documented medication management services in the aforementioned chronic conditions provided 6 months before, versus after, the intervention between the two groups, and identification of feasible quantitative outcomes for evaluating the effect of the intervention on patient care outcomes. Results: To date, the study has identified and enrolled the ten pharmacies required and initiated the intervention process. Conclusion: This study will be the first to examine the role of facilitation in pharmacy practice, with the goal of scalable and sustainable practice change. Trial registration: Clinicaltrials.gov identifier NCT02191111. Keywords: Pharmacy; Facilitation; Knowledge translation; Knowledge implementation
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    ABSTRACT: Background Hemodialysis patients experience poor outcomes associated with the presence of atherosclerosis, particularly lower-extremity peripheral artery disease (PAD). Prevalence of PAD is known to vary between ethnic groups; however, no information on ethnic-specific PAD prevalence in a hemodialysis cohort is available. Methods Data from the Canadian Kidney Dialysis Cohort Study was used in a secondary analysis of 1293 adults starting hemodialysis in three major Canadian centres. PAD diagnosis was determined through structured interview and supplemented by clinical record. Ethnicity was self-reported. Results Overall PAD prevalence was 19.1 % with no significant difference between ethnic groups. Ethnic differences observed in diabetes prevalence in the full hemodialysis group were not present in the subset of PAD patients. Conclusions The prevalence of PAD in patients undergoing hemodialysis is high, however we found no apparent ethnic differences in prevalence between ethnic groups.
    12/2014; DOI:10.1007/s40615-014-0066-7
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    ABSTRACT: Survivors of ischemic stroke/transient ischemic attack (TIA) are at high risk for other vascular events. We evaluated the impact of 2 types of case management (hard touch with pharmacist or soft touch with nurse) added to usual care on global vascular risk. This is a prespecified secondary analysis of a 6-month trial conducted in outpatients with recent stroke/TIA who received usual care and were randomized to additional monthly visits with either nurse case managers (who counseled patients, monitored risk factors, and communicated results to primary care physicians) or pharmacist case managers (who were also able to independently prescribe according to treatment algorithms). The Framingham Risk Score [FRS]) and the Cardiovascular Disease Life Expectancy Model (CDLEM) were used to estimate 10-year risk of any vascular event at baseline, 6 months (trial conclusion), and 12 months (6 months after last trial visit). Mean age of the 275 evaluable patients was 67.6 years. Both study arms were well balanced at baseline and exhibited reductions in absolute global vascular risk estimates at 6 months: median 4.8% (Interquartile range (IQR) 0.3%-11.3%) for the pharmacist arm versus 5.1% (IQR 1.9%-12.5%) for the nurse arm on the FRS (P = .44 between arms) and median 10.0% (0.1%-31.6%) versus 12.5% (2.1%-30.5%) on the CDLEM (P = .37). These reductions persisted at 12 months: median 6.4% (1.2%-11.6%) versus 5.5% (2.0%-12.0%) for the FRS (P = .83) and median 8.4% (0.1%-28.3%) versus 13.1% (1.6%-31.6%) on the CDLEM (P = .20). Case management by nonphysician providers is associated with improved global vascular risk in patients with recent stroke/TIA. Reductions achieved during the active phase of the trial persisted after trial conclusion. Copyright © 2014 Mosby, Inc. All rights reserved.
    American Heart Journal 12/2014; 168(6):924-30. DOI:10.1016/j.ahj.2014.08.001 · 4.56 Impact Factor
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    ABSTRACT: Background Access to health /disease screening (HDS) and medication monitoring /management (MM) services in New Zealand has traditionally been through general practitioners. While government and professional organisations are supportive of greater community pharmacy involvement, there has been little research on the extent of current provision or of the views of community pharmacists in this area.AimTo describe the characteristics and extent of HDS and MM services provided in New Zealand community pharmacies, and to document pharmacists’ opinions and perceived barriers in regard to the provision of these services.MethodsA four-part questionnaire was developed to record: the types of HDS /MM services offered by community pharmacies; the opinions of respondent pharmacists regarding these services; the characteristics of community pharmacies offering the services; and the profiles of the respondent pharmacists. The questionnaire was distributed to 879 community pharmacies in New Zealand.ResultsThere were 458 valid questionnaires returned, with a response rate of 52%. Over half (59%) of the responding pharmacies reported provision of HDS and /or MM services, although there were relatively few ‘high level’ services such as cardiovascular risk assessment and disease management. Most services were paid for by pharmacy customers, although some District Health Boards paid for services such as Medicines Use Review. Pharmacists cited lack of remuneration, lack of time and limited access to patient information as the main barriers to greater involvement.Conclusion At the time of this study (2007), community pharmacists in New Zealand were in the ‘early adoption’ phase concerning the provision of HDS and MM services.
    12/2014; 44(4). DOI:10.1002/jppr.1032
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    ABSTRACT: In 2010, unhealthy diets were estimated to be the leading risk for death and disability in Canada and globally. Although important, policies aimed at improving individual's skills in selecting and eating healthy foods has had a limited effect. Policies that create healthy eating environments are strongly recommended but have not yet been effectively and/or broadly implemented in Canada. Widespread adoption of healthy food procurement policies are strongly recommended in this policy statement from the Hypertension Advisory Committee with support from 15 major national health organizations. The policy statement calls on governments to take a leadership role, but also outlines key roles for the commercial and noncommercial sectors including health and scientific organizations and the Canadian public. The policy statement is based on a systematic review of healthy food procurement interventions that found them to be almost uniformly effective at improving sales and purchases of healthy foods. Successful food procurement policies are nearly always accompanied by supporting education programs and some by pricing policies. Ensuring access and availability to affordable healthy foods and beverages in public and private sector settings could play a substantive role in the prevention of noncommunicable diseases and health risks such as obesity, hypertension, and ultimately improve cardiovascular health. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 11/2014; 30(11):1456-9. DOI:10.1016/j.cjca.2014.06.021 · 3.94 Impact Factor
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    The Canadian journal of cardiology 10/2014; 31(2). DOI:10.1016/j.cjca.2014.09.005 · 3.94 Impact Factor
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    ABSTRACT: Background As evidence for the efficacy of pharmacists’ interventions, governments worldwide are developing legislation to formalize new practice approaches, including independent prescribing by pharmacists. Pharmacists in Alberta became the first in Canada availed of this opportunity; however, uptake of such has been slow. One approach to understanding this problem is through an examination of pharmacists who have already gained this ability. Objectives The primary objective of this study was to gain descriptive insight into the culture and personality traits of innovator, and early adopter, Alberta pharmacists with Additional Prescribing Authorization using the Organizational Culture Profile and Big Five Inventory. Methods The study was a cross-sectional online survey of Alberta pharmacists who obtained Additional Prescribing Authorization (independent prescribing authority), in the fall of 2012. The survey contained three sections; the first contained basic demographic, background and practice questions; the second section contained the Organizational Culture Profile; and the third section contained the Big Five Inventory. Results Sixty-five survey instruments were returned, for a response rate of 39%. Respondents’ mean age was 40 (SD 10) years. The top reason cited by respondents for applying for prescribing authority was to improve patient care. The majority of respondents perceived greater value in the cultural factors of competitiveness, social responsibility, supportiveness, performance orientation and stability, and may be more likely to exhibit behaviour in line with the personality traits of extraversion, agreeableness, conscientiousness and openness. Inferential statistical analysis revealed a significant linear relationship between Organizational Culture Profile responses to cultural factors of social responsibility and competitiveness and the number of prescription adaptations provided. Conclusions This insight into the experiences of innovators and early adopter pharmacist prescribers can be used to develop more specific and targeted knowledge implementation studies to improve the uptake and integration of prescribing by pharmacists.
    Research in Social and Administrative Pharmacy 09/2014; 11(3). DOI:10.1016/j.sapharm.2014.09.004 · 2.35 Impact Factor
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    ABSTRACT: Peripheral artery disease (PAD) is strongly associated with coronary artery disease and poor outcomes after coronary revascularization. The aim of this study was to test the hypothesis that patients with PAD diagnosed by a low ankle-brachial index (ABI; ≤0.90) have more complex coronary artery disease and more myocardium at risk than patients with normal ABIs (1.00 to 1.40) and that subsequent coronary revascularization is less complete. Adults referred for coronary angiography underwent ABI measurement using a standard Doppler ultrasound technique. Blinded reviewers calculated SYNTAX scores and Duke jeopardy scores at baseline and 3 months after angiography. Of 814 patients, 8% had PAD (ABI ≤0.90), 9% had borderline PAD (ABI 0.91 to 0.99), 77% were normal (ABI 1.00 to 1.40), and 7% had vascular calcification artifact (ABI >1.40). Patients with PAD were more likely to have high SYNTAX scores (≥33), with an odds ratio of 4.3 (95% confidence interval 1.2 to 14.9), compared with those with normal ABIs after adjustment for traditional cardiovascular risk factors. Similarly, there was a positive association between baseline high Duke jeopardy score (≥8) and PAD (adjusted odds ratio 3.5, 95% confidence interval 1.7 to 7.1). Postrevascularization high Duke jeopardy scores (≥5) were also positively associated with PAD (adjusted odds ratio 3.0, 95% confidence interval 1.1 to 8.8). In conclusion, PAD is associated with higher SYNTAX scores, more myocardium at risk, and less complete coronary revascularization than in patients with normal ABIs. More complex coronary artery disease and incomplete revascularization may contribute to worse cardiovascular outcomes in patients with PAD.
    The American Journal of Cardiology 09/2014; 114(11). DOI:10.1016/j.amjcard.2014.09.010 · 3.43 Impact Factor
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    ABSTRACT: Purpose of review: Studies on collaborative and multidisciplinary approaches to the management of hypertension published in the past two years are summarized. Expanding scopes of practice for non-physician health professionals, a need to build capacity in the healthcare system, and a movement toward multidisciplinary care warrant an examination of the evidence in this area. Recent findings: Multidisciplinary care for hypertension management, across the majority of studies identified, resulted in improved blood pressure outcomes and the timeliness of achieving treatment targets. Interventions involving therapeutic decision-making by non-physician health professionals consistently resulted in significant blood pressure improvements compared to usual care, while more passive approaches such as education and lifestyle monitoring programs were unable to significantly benefit participants’ blood pressure. Summary: Our findings support recent efforts to integrate collaborative care approaches into chronic disease management, with the strongest evidence for pharmacist care. Expanding scopes of practice and clinical decision-making protocols for nurses, pharmacists, dietitians, and physiotherapists have the potential to further improve hypertension care.
    Current Opinion in Cardiology 07/2014; 29(4):344-353. DOI:10.1097/HCO.0000000000000071 · 2.59 Impact Factor
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    ABSTRACT: Expansion of scope of practice and diminishing revenues from dispensing are requiring pharmacists to increasingly adopt clinical care services into their practices. Pharmacists must be able to receive payment in order for provision of clinical care to be sustainable. The objective of this study is to update a previous systematic review by identifying remunerated pharmacist clinical care programs worldwide and reporting on uptake and patient care outcomes observed as a result.
    Canadian Pharmacists Journal 07/2014; 147(4):209-32. DOI:10.1177/1715163514536678
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    Canadian Pharmacists Journal 05/2014; DOI:10.1177/1715163514535341
  • Ross T Tsuyuki
    The Canadian journal of hospital pharmacy 05/2014; 67(3):226-9. DOI:10.4212/cjhp.v67i3.1360
  • Ross T Tsuyuki

Publication Stats

6k Citations
974.19 Total Impact Points

Institutions

  • 1998–2015
    • University of Alberta
      • • Department of Medicine
      • • Division of Cardiology
      • • Faculty of Medicine and Dentistry
      • • Faculty of Pharmacy and Pharmaceutical Sciences
      Edmonton, Alberta, Canada
    • Instituto Dante Pazzanese de Cardiologia - Fundação Adib Jatene
      San Paulo, São Paulo, Brazil
  • 2013
    • TEC Edmonton
      Edmonton, Alberta, Canada
  • 2002–2013
    • University of Toronto
      • • Leslie L. Dan Faculty of Pharmacy
      • • Department of Medicine
      Toronto, Ontario, Canada
  • 2012
    • Curtin University Australia
      • School of Pharmacy
      Bentley, Western Australia, Australia
  • 2009
    • Alberta Health Services
      Calgary, Alberta, Canada
  • 2007–2008
    • The University of Calgary
      • Department of Community Health Sciences
      Calgary, Alberta, Canada
  • 2005
    • Institute of Health Economics
      Edmonton, Alberta, Canada
  • 2004
    • University of Lausanne
      Lausanne, Vaud, Switzerland
  • 1994–2004
    • University of British Columbia - Vancouver
      • • Department of Medicine
      • • Faculty of Pharmaceutical Sciences
      Vancouver, British Columbia, Canada
  • 2003
    • UHN: Toronto General Hospital
      Toronto, Ontario, Canada
  • 2001
    • University of the Sciences in Philadelphia
      • Department of Chemistry and Biochemistry
      Philadelphia, Pennsylvania, United States